Healthcare Provider Details

I. General information

NPI: 1841985892
Provider Name (Legal Business Name): KID SMART THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17786 SW 139TH CT
MIAMI FL
33177-7741
US

IV. Provider business mailing address

17786 SW 139TH CT
MIAMI FL
33177-7741
US

V. Phone/Fax

Practice location:
  • Phone: 786-316-6276
  • Fax:
Mailing address:
  • Phone: 786-316-6276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. IVETTE MARIA DUBOY GONZALEZ
Title or Position: MANAGING DIRECTOR
Credential: OTR/L
Phone: 786-316-6276